CVD burden in cancer varies by sex, age, income, cancer subtype
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Men, older patients and patients with low income were among those with elevated risk for CVD hospitalization prior to receiving a diagnosis of potentially curable cancer, researchers reported.
Published in JACC: CardioOncology, new data suggest that patients with stage I to IIIA non-small-cell lung cancer experienced the greatest risk for CVD, and those with stage I to III breast cancer experienced the lowest CVD risk compared with patients with other potentially curable cancer types.
“Pre-existing CVD in individuals with potentially curable cancer has been described in various countries. However, this has not been widely reported in England,” Nicolò Matteo Luca Battisti, MD, oncologist in the breast unit of The Royal Marsden NHS Foundation Trust in London, and colleagues wrote. “Investigating the intersection of cancer and CVD is central to understanding outcomes, informing cancer policy, and service provision.”
To better understand the associations between characteristics of patients and cancers and CVD prevalence, researchers linked National Cancer Registration Dataset, Hospital Episode Statistics and National Institute for Cardiovascular Outcomes Research datasets to identify 634,240 patients with potentially curable cancers (mean age, 67 years; 48% men; 89% white).
Cancer diagnoses included stage I to III breast cancer, stage I to III colon cancer, stage I to III rectal cancer, stage I to III prostate cancer, stage I to IIIA non-small-cell lung cancer, stage I to IV diffuse large B-cell lymphoma and stage I to IV Hodgkin lymphoma.
Breast cancer was the most common potentially curable cancer diagnosis, followed by prostate cancer, colon cancer, non-small-cell lung cancer, rectal cancer, diffuse large B-cell lymphoma and Hodgkin lymphoma.
“CVD is also an increasingly prevalent exclusion criterion for studies investigating novel anticancer treatments,” the researchers wrote. “This has substantial implications on limiting not only the access of patients with cancer to experimental treatments but also trial results applicability, trial design, drug development, and drug labeling.”
Within the overall cohort, 16.2% of patients had prior CVD.
Researchers reported that the likelihood of prior CVD hospitalization in patients with potentially curable cancer increased with age, the income domain of the Index of Multiple Deprivation and Charlson comorbidity index.
The odds of prior CVD hospitalization were also elevated among men compared with women.
The cancer diagnosis with the highest proportion of patients with prior CVD was non-small-cell lung cancer (36.1%), followed by colon cancer (22.1%), diffuse large B-cell lymphoma (21.7%), rectal cancer (16.8%), prostate cancer (15.4%), Hodgkin lymphoma (11.6%) and breast cancer (7.7%).
After adjustment for age, sex, income and comorbidities, the odds for prior CVD hospitalization were higher in all other potentially curable cancer diagnoses compared with breast cancer.
Among patients with potentially curable cancer, the most common reason for CVD hospitalization was ischemic heart disease, followed by congestive HF, peripheral artery disease, cerebrovascular disease, valvular heart disease, acute MI and stroke.
The rate of CVD among patients least income-deprived, as determined by the Index of Multiple Deprivation, was approximately 13.3%, and was approximately 20.7% among those considered most income-deprived.
“We have identified categories in which CVD is particularly common: older adults, those with non-small-cell lung cancer, and those living in deprived areas,” the researchers wrote. “These factors have important implications on the provision of cardio-oncology services across England, to ensure service distribution matches need.”
Prevalent CVD may limit cancer treatment
In a related editorial, Mamas A. Mamas, DPhil, MRCP, professor of cardiology in the Keele Cardiovascular Research Group at Keele University in Staffordshire, U.K., and Andrija Matetic, MD, of the department of cardiology, University Hospital of Split, and the department of pathophysiology at the University of Split School of Medicine, Croatia, discussed how prevalent CVD in this patient population may hinder cancer treatment options and efficacy.
“Understanding differential patterns of CVD prevalence across various cancer types and population groups is important for appropriate risk stratification and for informing treatment planning,” Mamas and Matetic wrote. “Prevalent CVD may represent a contraindication for pursuing specific anticancer treatment options or may require changes in therapy that may influence the potential for curative treatment in individuals with cancer ... Prevalent CVD may limit the choice of therapeutic agents in the treatment of cancer.
“Cardiovascular risk assessment using guideline-recommended risk stratification tools and multimodality noninvasive imaging should be used in all patients diagnosed with cancer, to better define prevalent CVD and future cardiovascular risk,” the editorial authors wrote.
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